Q&A GRADE A
3 pitting edema - (CORRECT ANSWER)a nurse is preparing to document info about
a client's lower leg, which are swollen with 6mm edema, which info should the nurse
document?
the client's output was 60ml for the past 3 years - (CORRECT ANSWER)a nurse is
caring for a client who has chronic kidney disease. the nurse should identify that
which of the following findings is the priority?
take vitamin D supplements - (CORRECT ANSWER)a nurse in a provider's office is
providing care for a middle adult client who has minimal exposure to sunlight. which
interventions should the nurse recommend?
observe the client's non-verbal indications of pain. - (CORRECT ANSWER)a nurse is
caring for an older adult client who has advanced rheumatoid arthritis but seldom
request paid medications, which action should the nurse take?
the client shrugs her shoulders while the nurse applies firm pressure over shoulders.
- (CORRECT ANSWER)a nurse is checking a client's muscle strength. which
techniques should the nurse use?
actual loss - (CORRECT ANSWER)a nurse is caring for a client who is postoperative
following a mastectomy. the client state, "I can barely look at myself in the mirror."
the nurse should identify that the client is experiencing which of the following?
Orthopneic - (CORRECT ANSWER)a nurse is caring for a client who is dyspnea
caused by a respiratory infection. the nurse should assist the client into which of the
following positions?
put the client's bed in the lowest position. - (CORRECT ANSWER)a nurse is caring
for a client who is at risk for falls. which action should the nurse take?
remove the cover ground in the client's room after providing care. - (CORRECT
ANSWER)a nurse is planning to administer meds to a client who has c-diff. to
prevent the transmission of this infection to others, which action should the nurse
plan to take?
the client has redness and warmth in his calf - (CORRECT ANSWER)a nurse is
collecting data from a client who is 1 day post-op following an abdominal surgery.
which finding is priority for the nurse to report to the provider.
turn off the faucet with a paper towel after drying hands. - (CORRECT ANSWER)a
nurse is preparing to obtain a client's vital signs. when washing her hands, what
action should the nurse take?
1. wash hands after removing gloves
2. use antimicrobial hand gel after refilling client's water pitcher.
3. clean the stethoscopebwith an antimicrobial wipe after obtaining vital signs. -
(CORRECT ANSWER)a nurse is caring for a group of client's in a long term care
, facility. what action should the nurse take to prevent healthcare associated infections
for these client's.
"you should cover your mouth with a tissue when you cough" - (CORRECT
ANSWER)a nurse is teaching a client who has pneumonia and a productive cough.
what instruction should the nurse include?
guided imagery - (CORRECT ANSWER)a nurse is caring for a client who has
chronic pain . the nurse recommends that the client concentrate on a memory of a
pleasurable experience , which complementary therapies is the nurse suggested?
release of personal belongings form - (CORRECT ANSWER)a nurse is an acute
care setting is documenting post mortem care for a client. what info should the nurse
include in the documentation?
support the client's feet with foot boots - (CORRECT ANSWER)a nurse is
contributing to the plan of care for a client who is at risk for developing foot drop due
to immobility. what actions should the nurse recommend?
Ego Integrity vs. Despair - (CORRECT ANSWER)a nurse working in a community
clinic is talking with an older adult client who state's that his life has no purpose. the
nurse should I'D that the client is in which of the following stages?
measure the client's gastric residual before each feeding - (CORRECT ANSWER)a
nurse is caring for a client who is receiving intermittent eternal feedings. what is the
priority action for the nurse to take?
"you seem really afraid. Let's talk more about your feelings" - (CORRECT
ANSWER)a nurse is caring for a client who has breast cancer and expresses fear
about the future. what responses should the nurse make?
provide info to another nurse at change of shift. - (CORRECT ANSWER)a nurse is
caring for a client who has a new diagnosis of cancer. which action should the nurse
take to maintain the client's confidentiality while providing care?
constipation - (CORRECT ANSWER)a nurse is collecting data from a client who
requires bedrest and reports abdominal discomfort. the nurse notes abdominal
distention. which condition should the nurse I'D as an adverse effect of bed rest?
three-point - (CORRECT ANSWER)a nurse is evaluating the crutch walking
technique of a client who is required to keep weight off her right leg. what is the
proper crutch gait for this patient?
"the client became short of breath when ambulating" - (CORRECT ANSWER)a
nurse is documenting client care in a client's electronic health record. which
statement should the nurse include in the documentation?
1. assess the client's gag reflex
2. head turned to the side
3. protect bed linens
3 pitting edema - (CORRECT ANSWER)a nurse is preparing to document info about
a client's lower leg, which are swollen with 6mm edema, which info should the nurse
document?
the client's output was 60ml for the past 3 years - (CORRECT ANSWER)a nurse is
caring for a client who has chronic kidney disease. the nurse should identify that
which of the following findings is the priority?
take vitamin D supplements - (CORRECT ANSWER)a nurse in a provider's office is
providing care for a middle adult client who has minimal exposure to sunlight. which
interventions should the nurse recommend?
observe the client's non-verbal indications of pain. - (CORRECT ANSWER)a nurse is
caring for an older adult client who has advanced rheumatoid arthritis but seldom
request paid medications, which action should the nurse take?
the client shrugs her shoulders while the nurse applies firm pressure over shoulders.
- (CORRECT ANSWER)a nurse is checking a client's muscle strength. which
techniques should the nurse use?
actual loss - (CORRECT ANSWER)a nurse is caring for a client who is postoperative
following a mastectomy. the client state, "I can barely look at myself in the mirror."
the nurse should identify that the client is experiencing which of the following?
Orthopneic - (CORRECT ANSWER)a nurse is caring for a client who is dyspnea
caused by a respiratory infection. the nurse should assist the client into which of the
following positions?
put the client's bed in the lowest position. - (CORRECT ANSWER)a nurse is caring
for a client who is at risk for falls. which action should the nurse take?
remove the cover ground in the client's room after providing care. - (CORRECT
ANSWER)a nurse is planning to administer meds to a client who has c-diff. to
prevent the transmission of this infection to others, which action should the nurse
plan to take?
the client has redness and warmth in his calf - (CORRECT ANSWER)a nurse is
collecting data from a client who is 1 day post-op following an abdominal surgery.
which finding is priority for the nurse to report to the provider.
turn off the faucet with a paper towel after drying hands. - (CORRECT ANSWER)a
nurse is preparing to obtain a client's vital signs. when washing her hands, what
action should the nurse take?
1. wash hands after removing gloves
2. use antimicrobial hand gel after refilling client's water pitcher.
3. clean the stethoscopebwith an antimicrobial wipe after obtaining vital signs. -
(CORRECT ANSWER)a nurse is caring for a group of client's in a long term care
, facility. what action should the nurse take to prevent healthcare associated infections
for these client's.
"you should cover your mouth with a tissue when you cough" - (CORRECT
ANSWER)a nurse is teaching a client who has pneumonia and a productive cough.
what instruction should the nurse include?
guided imagery - (CORRECT ANSWER)a nurse is caring for a client who has
chronic pain . the nurse recommends that the client concentrate on a memory of a
pleasurable experience , which complementary therapies is the nurse suggested?
release of personal belongings form - (CORRECT ANSWER)a nurse is an acute
care setting is documenting post mortem care for a client. what info should the nurse
include in the documentation?
support the client's feet with foot boots - (CORRECT ANSWER)a nurse is
contributing to the plan of care for a client who is at risk for developing foot drop due
to immobility. what actions should the nurse recommend?
Ego Integrity vs. Despair - (CORRECT ANSWER)a nurse working in a community
clinic is talking with an older adult client who state's that his life has no purpose. the
nurse should I'D that the client is in which of the following stages?
measure the client's gastric residual before each feeding - (CORRECT ANSWER)a
nurse is caring for a client who is receiving intermittent eternal feedings. what is the
priority action for the nurse to take?
"you seem really afraid. Let's talk more about your feelings" - (CORRECT
ANSWER)a nurse is caring for a client who has breast cancer and expresses fear
about the future. what responses should the nurse make?
provide info to another nurse at change of shift. - (CORRECT ANSWER)a nurse is
caring for a client who has a new diagnosis of cancer. which action should the nurse
take to maintain the client's confidentiality while providing care?
constipation - (CORRECT ANSWER)a nurse is collecting data from a client who
requires bedrest and reports abdominal discomfort. the nurse notes abdominal
distention. which condition should the nurse I'D as an adverse effect of bed rest?
three-point - (CORRECT ANSWER)a nurse is evaluating the crutch walking
technique of a client who is required to keep weight off her right leg. what is the
proper crutch gait for this patient?
"the client became short of breath when ambulating" - (CORRECT ANSWER)a
nurse is documenting client care in a client's electronic health record. which
statement should the nurse include in the documentation?
1. assess the client's gag reflex
2. head turned to the side
3. protect bed linens
